Chronic liver disease related to 6-thioguanine in children with acute lymphoblastic leukaemia

被引:44
作者
De Bruyne, R
Portmann, B
Samyn, M
Bansal, S
Knisely, A
Mieli-Vergani, G
Dhawan, A
机构
[1] Kings Coll Hosp London, Dept Child Hlth, Paediat Liver Unit, London SE5 9RS, England
[2] Kings Coll Hosp London, Inst Liver Studies, London SE5 8RX, England
关键词
6-thioguanine; UK ALL 97/99 clinical trial; acute lymphoblastic leukaemia; nodular regenerative hyperplasia; portal hypertension; hepatic toxicity; children;
D O I
10.1016/j.jhep.2005.06.020
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background/Aims: The United Kingdom (UK) acute lymphoblastic leukaemia (ALL) 97/99 clinical trial compared 6-mercaptopurine (6MP) with 6-thioguanine (6TG) as maintenance therapy for childhood ALL. Review of interim results has led to discontinuation of the 6TG arm. Methods: We report six children with ALL, who presented with splenomegaly after a median (range) treatment duration of 12 (6-22) months. All these children were treated in the 6TG-arm. Results: The median (range) age at presentation was 6.6 (3.2-11.5) years. There were five boys. The presenting features were splenomegaly in all and hepatomegaly in four. AST was abnormal in one (80 IU/l, normal range 10-50). Abdominal sonography showed an altered texture of the liver parenchyma and confirmed splenomegaly. Microscopy showed findings within the spectrum of occlusive venopathy and nodular regenerative hyperplasia (NRH). After a median (range) follow-up of 23 (4-36) months splenomegaly and thrombocytopenia, suggestive of progressive portal hypertension, continue to worsen in all children. Conclusions: 6TG is associated with chronic hepatic toxicity and progressive portal hypertension on follow-up. Microscopy showed NRH in all patients with features in keeping with an intrahepatic occlusive venopathy and variable parenchymal atrophy and loss. (C) 2005 Published by Elsevier B.V. on behalf of the European Association for the Study of the Liver.
引用
收藏
页码:407 / 410
页数:4
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